Establishing Consensus in the Diagnosis of Gestational Diabetes Following HAPO: Where Do We Stand?

Abstract

New proposals for the diagnosis of gestational diabetes (GDM), promulgated by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), will substantially increase the number of women diagnosed with GDM. This will have an enormous impact on healthcare resources, diverting attention away from genuinely high risk diabetic pregnancies. Randomized trials in 'mild' GDM indicate that the main effects of treatment are a 2 %-3 % reduction in birth weight, fewer 'big babies', and less shoulder dystocia. However, these studies used different diagnostic criteria, and women diagnosed by the broader IADPSG criteria may not derive the same modest benefit. Modeling indicates a very high cost per QALY, unless later development of type 2 diabetes can be prevented. Far from producing consensus, the IADPSG suggestion has thrown sharply into focus the need to assess critically the risks, costs and benefits of adopting criteria that may pathologize a large number of otherwise normal pregnancies.

Gestational diabetes mellitus among Norwegian women with polycystic ovary syndrome: prevalence and risk factors according to the WHO and the modified IADPSG criteria

“…GDM diagnosis correlated with less maternal weight loss the first year post-partum. A general increase in GDM incidence when using the IADPSG criteria instead of the WHO criteria is well documented (23,24). To our knowledge, the prevalence of GDM according to the IADPSG criteria in PCOS women has not been reported previously.…”

Diagnosing gestational diabetes mellitus: implications of recent changes in diagnostic criteria and role of glycated haemoglobin (HbA1c)

“…While these guidelines aimed to provide a more evidence-based consensus to GDM screening, there remain some concerns about their impact on services, including whether the additional women identified using this approach include a number of women with 'mild GDM' whose pregnancy outcomes might not warrant the additional burden of this approach to screening. 12 In 2015, the UK National Institute for Health and Care Excellence (NICE) issued separate recommendations, which sought to take into account recent publications examining the potential impact of the 2013 WHO guidance. 13 An additional factor is the rising use of glycated haemoglobin (HbA1c) as a diagnostic tool following the publication of the WHO criteria for the diagnosis of T2DM.…”

“…Hence, the choice of which criteria to adopt remains a balance between minimising pressure on stretched healthcare services and providing the optimum service for patients. 12 …”

Counterpoint: Establishing Consensus in the Diagnosis of GDM Following the HAPO Study

“…The HAPO data are downplayed and in some instances misrepresented by Long and Cundy (10). The study was designed to evaluate the relationship between milder degrees of hyperglycemia and pregnancy outcomes, not, as contended by Long and Cundy, because the investigators were “hoping to find” a presumed inflection point for GDM diagnosis.…”

“…In 2013, Current Diabetes Reports published a review by Long and Cundy (10) under the title of “Establishing consensus in the diagnosis of gestational diabetes: where do we stand?” These two authors are among the most vocal opponents of the developing international consensus regarding GDM diagnosis and presented their article as “a counterpoint to what we believe is an unjustified change of practice”. Thus, the current article essentially comprises a “counterpoint to a counterpoint”.…”